[!INFO] Definitions:
left ventricular hypertrophy = increased left ventricular mass.
Hypertrophy is divided into concentric and eccentric based on the "relative ventricular wall thickness".
This in turn is defined as "ventricular wall thickness divided by LV diastolic diameter".
- If relative wall thickness is high, it's called concentric.
- If relative wall thickness is low, it's called eccentric. Source
Source
Vertical transmission can occur from other to baby by
[!INFO] Mnemonic CLAP TORCHES
[!INFO] Mnemonic: 3 viruses, 5 bacteria
[!INFO] Viruses which only rarely cross the placenta
HIV, HSV, Hep B, EBV.
More frequently, they are transmitted perinetally
#TODO read routes of infection from this source.
| Toxoplasmosis | Rubella | CMV | Herpes | Enterovirus | Syphillis |
|---|---|---|---|---|---|
| CCCc | BCDG | All S's | |||
| Chorioretinitis Convulsions Calfications cephalus - hydro / micro |
Blindnes Cataracts Deafness Growth impairment |
T1: Microcephaly, seizures, chrorioretinitis Later: Hepatitis, pneumonia |
Mucocutaneous vessicles Conjunctivitis Other organs (seizurse, ⬆liver enzymes) |
myocarditis Encephalitis Hearing loss |
Skin Skeletal Splenomegaly Saddle nose Smile (Hutchison's teeth) |
| Highest risk - T1 (50-90% risk) | Commonest congenital infection (30% risk) |
| Chlamydia | Listeria | AIDS | Parvovirus |
|---|---|---|---|
| Conjunctivitis Pneumonia |
Amnionitis Neonatal sepsis |
Neonatal death or hydrops; but most do not have adverse outcomes. (UpToDate) |
Presentation depends on time of infection:
[!INFO] mnemonic: patient numbers
Phase I - double digits
Phase II - Triple digits
Phase III - quadruple digits, also C being the 3rd letter of the alphabet, phase III trials 'compare' efficacy -> RCTs.
[!INFO] The Big 5 STIs
Chlamydia, gonorrhoea, Syphilis, HIV, hepatitis B,
and trichomoniasis.
[[AntirabiesPostExposure.pdf]]
2 site intradermal - 2,2,2,0,2
on day 0,3,7,30
4 site intradermal is similar - 4,2,2,0,2
recommended for late presentaion, border line exposure or major exposure from observable healthy domestic animal.
IM arv course is on day 0,3,7,14,30.
something called the 2-2-1 regimen is used for minor exposurse.
Caused by HHV-4. (human herpevirus 4) [[viralClassificationFamilies.png]]
⭐MCD in adults:
- NSAID induced
- NSAIDS can cause haemodynamically mediated AKI and Acute Interstitial nephritis - which can lead to MCD.Source
- Lithium, mercury - (both also a cause for membranous nephropathy)
- Malignancies, particulartly haematologic ones: Hodgkin lymphoma and non hodgkin lymphoma (paraneoplastic)
| Primary FSGS | Secondary FSGS |
|---|---|
| Sometimes responds to steroids, failure of steroids is common. Other immunosuppresants are used. | Usually poor response to steroids. ACEi are better |
| Presents as massive proteinuria, haematuria and hypertension. | Can be caused by any process which reduces functioning number of nephrons (eg. nephrectomy) |
| (nephrectomy, hypertension, gross obesity, IgA nephropathy, HIV, CMV, EBV, hepatitis B and C) | |
| Lithium, Heroin, bisphosphonates (Pamidronate), anabolic steroids, | |
| reflux nephropathy | |
| Sickle cell disease [[Haematology MCQ discussion#Q5 Sickle cell disease]] | |
| Source |
- 
- Electrophoresis of urine samples in different diseases: [Source](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874928/)
- Despite this electrophoresis clearly showing that MCD doesn't loose much IgG, *infection is a well known complication of minimal change disease*. [Source](https://emedicine.medscape.com/article/244631-overview#showall)(maybe due to complement loss, steroids etc)
⭐Membranous nephropathy -
- Need to exclude hepatitis B, SLE, thyroiditis, some drugs (penicillamine, gold / mercury, captopril) and malignancy.
- Associated malignancies: prostate, lung, lymphoma, leukemia
Prognosis - rule of thirds (passMedicine)
[!TIP] Mnemonic:
Marie : Odd ones out (odd numbers affect the 'external' myelin
[!INFO] see also
[[General Medicine 4#Q 12 Rabies prophylaxis|Rabies prophylaxis]]
Eosinophillic, **cytoplasmic** inclusions of viral proteins visible in the *hippocampus and cerebellum*.
- Immunosuppresed people get complications -> pyrimethamine is first line drug.
PKD genes encode the polycystin proteins. Mutations of these cause decreased intracellular calcium in the principal cells of the collecting duct -> dysoriented cell division -> cyst formation.
Polycystin 1 (in PKD1) is a regulator of tubular epithelial cell adhesion and differentiation. Polycystin 2 (in PKD2) is an ion channel. These are required for function of cilia of the tubular epithelium which are in turn required for flow sensing. Impaired flow sensing causes a defect in proliferation and differentiation -> cysts.
Cyst formation occurs only in 5-10% of nephrons but that's enough to cause renomegaly.
Caplan Syndrome
Necator americanus ("American murderer") , ancylostoma duodenale
and ancylostoma ceylonicum
Ancylostoma ceylonicum is endemic in dogs and cats as well as humans.
Ancylostoma caninum from dogs can infect human intestine but does not reach reproductive maturity.
Another group of hookworms infecting animals can penetrate the human skin causing cutaneous larva migrans (A. braziliense, A. caninum, Uncinaria stenocephala). Other than A. caninum noted above, these parasites do not develop further after their larvae penetrate human skin
[!TIP] Mnemonic:
Hookworm - larva migrans.(slow)
Strongyloides -> larva currens (fast)
Strongyloides are strong -> therefore move fast -> "currens"
Proteins which are normally soluble start getting deposited extracellularly as beta pleted fibrils.
1. Dialysis-related amyloidosis (DRA) is a disabling disease characterized by accumulation and tissue deposition of amyloid fibrils consisting of beta2-microglobulin (beta2-m) (Aβ2M) in the bone, periarticular structures, and viscera of patients with end-stage kidney disease. Beta2-m is a component of the major histocompatibility complex that is present on cell surfaces and is normally cleared by glomerular filtration
2. Aβ2M amyloidosis presents with carpal tunnel syndrome.
[!INFO] Once the presense of amyloid is found
the precursor protein must be determined.
(Both (AL and AA) have the beta pleted sheet structure) (Harrison's - page 804)
| Type | Constituent |
| ------------------------- | --------------------------------------------------------------------------------------------------------------------------------- |
| AL Amyloidosis | Deposition of Ig Light chain fragments |
| Transthyretin amyloidosis | |
Commonest involved organs:
The symptoms and signs of AL and AA cannot reliably be distinguished. - Harrison's
AA amyloido is derived from a serum precursor called serum amyloid associated protein. (SAA protein).
It is made in the liver under the stimulation of IL-1, and IL-6.
Found in Alzheimer's disease.
The precursor for this is Amyloid precursor proteins. (APP)
- *Probenecid* - avoid in renal impairment
- **Anakinra** - *IL-1 inhibitor*; very expensive.
[!WARNING]
Hypoparathyroidism in the image is probably incorrect; most sources say hyperparathyroidism.P is for positive - peudogout pyrophosphate crystals show positive birefrigence.
| Gout | Pseudogout | |
|---|---|---|
| Uric acid crystal | Calcium pyrophosphate | |
| Needle shaped, negatively birefingent | Rhomboid shaped, positively birefringent | |
| Associated with triggers (heavy meal, alcohol, illness, dehydration) | No acute triggers | |
| Risk factors: | Joint damange, OA, increased age | |
| also associated with GOUT, hyperparathyroidism, hypomagnesemia, haemochromatosis | ||
| Joint fluid can look purulent. | ||
| Commoner in males | Male = female. | |
| 30 - 60 years | Older - ? 70 years | |
| Uric acid levels fall immediately after an episode | ||
| Commonest joint: MTP, also wrist, ankle | knee, elbow, wrist, ankle | |
| #2015MCQ/Q35 |
- (?not following viral infection)
- Also plantar fasciits, achilles tendinits, balanitis, anterior uveitis
Enthesitis causing plantar fascitis or achilles tendon enthesitis can occur. Also dacytilitis
Skin and nail lesions resembling psoriasis
Reiters is more prevalent among indiviuals with HIV. It can predate the symptoms of HIV. Can present as oligoarthritis.
Listeria is a beta haemolytic gram +ve bacillus.
They are ubiquitous in the environment and can be present in the human gut.
Spread via contaminated food.
Diagnosis requires blood culture; Faecal culture is not sensitive.
Suspect due to clinical context as infections can occur in clusters / outbreaks.
They can cause a watery diarrhoea [[2022-November#^5eaea3|watery Diarrhoea]]
Clinical manifestations:
In immunocompetent people, infection is asymptomatic.
The bacteria multiply intracellularly and therefore, require cell mediated immunity for control.
Therefore, following groups are at risk;
In at risk patients, bacteraemia leads to high fever without localizing signs leading to endocarditis, peritonitis, osteomyelitis, septic arthritis, cholecystitis and pneumonia, meningitis and occuloglandular listeriosis (ophthalmitis and lymph node enlargement - Parinaud syndrome).
Treatment: Ceftriaxones are ineffective. Ampicillin + gentamicin (as this combination shows synergy) for at least 2 weeks.
^36d6c8
[!TIP] Mnemonic: TAMPAX -> "TAMPOX"
TAMponade - Pulsus paradoxus and only X descent are seen. (Y descent is absent)
Constrictive -> "Konsrictive" -> Kussmaul sign [[#^36d6c8]] is present in constrictive pericarditis.
| Left and Right ventricular diastolic pressure and left and right atrial pressures (PCWP) all rise to match the pericardial pressure. (i.e ?no pressure gradient from atrium to ventricle -> impaired flow across TV -> absent Y descent) |?Greatly increased ventricular interdependance|
- Acute toxicity can produce motor symptoms -> Course tremmor.
Always over 50;
[!INFO] The only enterovirus we have a vaccine for is polio virus.